Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

ENC-00169: Lena Okafor

89M · MRN85625659 · Hospital Medicine · admitted Sun Nov 08, 2026 06:29 PM · in hospital · attending Dr. Cyrus Ellingham · resident Dr. Elena Nakashima · 176 cm, 88.3 kg

Documented diagnoses (current)

Principal: “upper GI bleed” · K92.2 Gastrointestinal hemorrhage, unspecified
“stage 4 sacral pressure ulcer” · L89.154 Pressure ulcer of sacral region, stage 4
“GERD” · K21.9 Gastro-esophageal reflux disease without esophagitis

Illustrative grouping now: MS-DRG 377 GI hemorrhage with MCC. If every open specificity/validation gap were answered as the criteria suggest: MS-DRG 378.

Queries and events

No queries yet.

All rules applied

Rule Criteria Finding Outcome

Acute kidney injury

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule aki v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: meets_definition	`creat_ratio >= t.ratio_s1 or creat_rise_48h >= t.rise_abs or coalesce(uo_hours_lt_0_5 >= t.uo_s1_h, false)`	creat_ratio=1.062, t.ratio_s1=1.5, creat_rise_48h=0.04, t.rise_abs=0.3, uo_hours_lt_0_5=unknown, t.uo_s1_h=6	false
derived: stage3	`meets_definition and (creat_ratio >= t.ratio_s3 or creat_peak >= t.scr_s3 or rrt_started or coalesce(uo_hours_lt_0_3 >= t.uo_s3_h, false) or coalesce(anuria_hours >= t.anuria_h, false))`	meets_definition=False, creat_ratio=1.062, t.ratio_s3=3.0, creat_peak=1.02, t.scr_s3=4.0, rrt_started=False, uo_hours_lt_0_3=unknown, t.uo_s3_h=24, anuria_hours=unknown, t.anuria_h=12	false
derived: stage2	`creat_ratio >= t.ratio_s2 or coalesce(uo_hours_lt_0_5 >= t.uo_s2_h, false)`	creat_ratio=1.062, t.ratio_s2=2.0, uo_hours_lt_0_5=unknown, t.uo_s2_h=12	false
derived: stage	`case(stage3, 3, stage2, 2, meets_definition, 1, 0)`	stage3=False, stage2=False, meets_definition=False	0
derived: baseline_independent	`creat_baseline_known or creat_rise_48h >= t.rise_abs or rrt_started`	creat_baseline_known=True, creat_rise_48h=0.04, t.rise_abs=0.3, rrt_started=False	true
outcome: aki_staged	`stage >= 1 and baseline_independent`	stage=0, baseline_independent=True	false
outcome: aki_presumed_baseline	`stage >= 1`	stage=0	false
outcome: not_met	`stage == 0`	stage=0	true

Acute blood loss anaemia

Criteria met

Specificity gap

Criteria support Acute blood loss anemia (D62); no corresponding diagnosis is documented.

Trace

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: anaemic	`case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null)`	sex=M, hgb_nadir=9.9, t.hb_m=13, t.hb_f=12	true
derived: acute_fall	`hgb_drop >= t.drop_major or prbc_units >= t.prbc_major`	hgb_drop=2.9, t.drop_major=2.0, prbc_units=2, t.prbc_major=2	true
outcome: met	`bleeding_documented and anaemic and acute_fall`	bleeding_documented=True, anaemic=True, acute_fall=True	true

Chronic kidney disease

Clinical judgement required

No gap

Not documented; egfr 60 or above; ckd g1-g2 requires markers of kidney damage, which are not assessed here.

Trace

Rule trace (rule ckd v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: chronic	`egfr_n >= 2 and egfr_span_days >= t.chronic_days`	egfr_n=2, egfr_span_days=357, t.chronic_days=90	true
derived: staging_egfr	`max(egfr_early, egfr_late)`	egfr_early=77.5, egfr_late=75.6	77.5
derived: both_below_60	`egfr_early < t.g2 and egfr_late < t.g2`	egfr_early=77.5, t.g2=60, egfr_late=75.6	false
derived: category	`case(staging_egfr >= t.g2, 'G1-G2', staging_egfr >= t.g3a, 'G3a', staging_egfr >= t.g3b, 'G3b', staging_egfr >= t.g4, 'G4', 'G5')`	staging_egfr=77.5, t.g2=60, t.g3a=45, t.g3b=30, t.g4=15	G1-G2
outcome: duration_not_shown	`not chronic`	chronic=True	false
outcome: straddles_60	`not both_below_60 and min(egfr_early, egfr_late) < t.g2`	both_below_60=False, egfr_early=77.5, egfr_late=75.6, t.g2=60	false
outcome: g1_g2	`staging_egfr >= t.g2`	staging_egfr=77.5, t.g2=60	true

Heart failure

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule heart_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: np_elevated	`coalesce(bnp_max >= t.bnp, false) or coalesce(ntprobnp_max >= t.ntprobnp, false)`	bnp_max=unknown, t.bnp=100, ntprobnp_max=unknown, t.ntprobnp=300	false
derived: acute_count	`count(iv_loop_diuretic, np_elevated, new_o2)`	iv_loop_diuretic=False, np_elevated=False, new_o2=False	0
derived: hf_type	`case(lvef <= t.ref, 'systolic', lvef >= t.pres, 'diastolic', 'midrange')`	lvef=unknown, t.ref=40, t.pres=50	unknown
derived: improved	`coalesce(lvef_prior_min <= t.ref and lvef > t.ref and lvef - lvef_prior_min >= t.improved_rise, false)`	lvef_prior_min=unknown, t.ref=40, lvef=unknown, t.improved_rise=10	false
derived: acuity	`case(acute_count >= 2 and hf_history, 'acute on chronic', acute_count >= 2, 'acute', acute_count == 0 and hf_history, 'chronic', null)`	acute_count=0, hf_history=False	unknown
outcome: improved_ef	`improved`	improved=False	false
outcome: midrange	`hf_type == 'midrange'`	hf_type=unknown	unknown
outcome: sys_aoc	`hf_type == 'systolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_acute	`hf_type == 'systolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: sys_chronic	`hf_type == 'systolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_aoc	`hf_type == 'diastolic' and acuity == 'acute on chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_acute	`hf_type == 'diastolic' and acuity == 'acute'`	hf_type=unknown, acuity=unknown	unknown
outcome: dia_chronic	`hf_type == 'diastolic' and acuity == 'chronic'`	hf_type=unknown, acuity=unknown	unknown
outcome: one_indicator	`acute_count == 1`	acute_count=0	false

Hyponatraemia

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=136.0, t.profound=125, t.moderate=130, t.low=135	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_min=136.0, t.low=135, na_low_count=0, t.repeat=2, na_treated=False	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Malnutrition

Insufficient data

No gap

Insufficient data: the criteria could not be applied.

Trace

Rule trace (rule malnutrition v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: a_sev_intake	`intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days`	intake_pct=unknown, t.a_sev_intake_pct=50, intake_days=unknown, t.a_sev_intake_days=5	unknown
derived: a_mod_intake	`intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days`	intake_pct=unknown, t.a_mod_intake_pct=75, intake_days=unknown, t.a_mod_intake_days=7	unknown
derived: a_sev_wt	`(wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: a_mod_wt	`(wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_sev_intake	`intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_mod_intake	`intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days`	intake_pct=unknown, t.c_intake_pct=75, intake_days=unknown, t.c_intake_days=30	unknown
derived: c_sev_wt	`(wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: c_mod_wt	`(wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20)`	wt_loss_days=unknown, wt_loss_pct=unknown	unknown
derived: n_assessed	`known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced)`	intake_pct=unknown, wt_loss_pct=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown	0
derived: n_severe	`case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_sev_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_sev_wt=unknown	unknown
derived: n_moderate	`case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null)`	nutr_context=unknown, a_sev_intake=unknown, a_mod_intake=unknown, a_sev_wt=unknown, a_mod_wt=unknown, fat_loss=unknown, muscle_loss=unknown, fluid=unknown, grip_reduced=unknown, c_sev_intake=unknown, c_mod_intake=unknown, c_sev_wt=unknown, c_mod_wt=unknown	unknown
outcome: severe	`n_severe >= 2`	n_severe=unknown	unknown
outcome: moderate	`n_moderate >= 2`	n_moderate=unknown	unknown
outcome: one_characteristic	`n_moderate == 1`	n_moderate=unknown	unknown
outcome: not_met	`n_moderate == 0 and n_assessed >= 2`	n_moderate=unknown, n_assessed=0	false

Obesity

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule obesity v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
outcome: not_adult	`age < t.adult`	age=89, t.adult=20	false
outcome: class3	`bmi >= t.c3`	bmi=28.5, t.c3=40	false
outcome: class2	`bmi >= t.c2`	bmi=28.5, t.c2=35	false
outcome: class1	`bmi >= t.c1`	bmi=28.5, t.c1=30	false
outcome: not_met	`bmi < t.c1`	bmi=28.5, t.c1=30	true

Pressure injury

Criteria met

Clinical validation gap

Documented “stage 4 sacral pressure ulcer” (L89.154) conflicts with what the criteria support (Pressure injury of sacral region, stage 2, L89.152).

Trace

Rule trace (rule pressure_injury v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sacral	`wound_site == 'sacral'`	wound_site=sacral	true
outcome: no_wound_note	`not present(wound_stage)`	wound_stage=2	false
outcome: other_site	`wound_site != 'sacral'`	wound_site=sacral	false
outcome: stage1	`sacral and wound_stage == '1'`	sacral=True, wound_stage=2	false
outcome: stage2	`sacral and wound_stage == '2'`	sacral=True, wound_stage=2	true

Acute respiratory failure

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule respiratory_failure v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: measured	`present(spo2_min_ra) or present(pao2_min_ra) or present(pf_min)`	spo2_min_ra=94.0, pao2_min_ra=unknown, pf_min=unknown	true
derived: hypoxemia	`coalesce(spo2_min_ra < t.spo2_ra, false) or coalesce(pao2_min_ra < t.pao2, false) or coalesce(pf_min < t.pf, false)`	spo2_min_ra=94.0, t.spo2_ra=88, pao2_min_ra=unknown, t.pao2=60, pf_min=unknown, t.pf=300	false
derived: distress	`coalesce(rr_max >= t.rr_distress, false) or coalesce(wob_increased, false) or adv_resp_support`	rr_max=20.0, t.rr_distress=28, wob_increased=unknown, adv_resp_support=False	false
outcome: chronic_baseline	`home_o2 and hypoxemia`	home_o2=False, hypoxemia=False	false
outcome: met	`hypoxemia and distress`	hypoxemia=False, distress=False	false
outcome: hypoxemia_only	`hypoxemia`	hypoxemia=False	false
outcome: not_met	`measured and not hypoxemia and o2_max_lpm <= t.o2_low and not adv_resp_support`	measured=True, hypoxemia=False, o2_max_lpm=0.0, t.o2_low=2, adv_resp_support=False	true

Sepsis

Criteria not met

No gap

Not documented and not supported.

Trace

Rule trace (rule sepsis v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: sirs_temp	`coalesce(temp_max_48h > t.t_hi, false) or coalesce(temp_min_48h < t.t_lo, false)`	temp_max_48h=37.2, t.t_hi=38, temp_min_48h=36.5, t.t_lo=36	false
derived: sirs_hr	`coalesce(hr_max_48h > t.hr, false)`	hr_max_48h=87.0, t.hr=90	false
derived: sirs_rr	`coalesce(rr_max_48h > t.rr, false) or coalesce(paco2_min_48h < t.paco2, false)`	rr_max_48h=19.0, t.rr=20, paco2_min_48h=unknown, t.paco2=32	false
derived: sirs_wbc	`coalesce(wbc_max_48h > t.wbc_hi, false) or coalesce(wbc_min_48h < t.wbc_lo, false) or coalesce(bands_max_48h > t.bands, false)`	wbc_max_48h=7.74, t.wbc_hi=12, wbc_min_48h=6.68, t.wbc_lo=4, bands_max_48h=unknown, t.bands=10	false
derived: sirs_count	`count(sirs_temp, sirs_hr, sirs_rr, sirs_wbc)`	sirs_temp=False, sirs_hr=False, sirs_rr=False, sirs_wbc=False	0
derived: sofa_resp	`coalesce(case(pf_min_48h < 100 and adv_resp_support, 4, pf_min_48h < 200 and adv_resp_support, 3, pf_min_48h < 300, 2, pf_min_48h < 400, 1, 0), 0)`	pf_min_48h=unknown, adv_resp_support=False	0
derived: sofa_coag	`coalesce(case(platelets_min_48h < 20, 4, platelets_min_48h < 50, 3, platelets_min_48h < 100, 2, platelets_min_48h < 150, 1, 0), 0)`	platelets_min_48h=186.0	0
derived: sofa_liver	`coalesce(case(bili_max_48h >= 12, 4, bili_max_48h >= 6, 3, bili_max_48h >= 2, 2, bili_max_48h >= 1.2, 1, 0), 0)`	bili_max_48h=0.42	0
derived: sofa_cardio	`coalesce(case(norepi_max_48h > 0.1, 4, norepi_max_48h > 0, 3, map_min_48h < 70, 1, 0), 0)`	norepi_max_48h=0.0, map_min_48h=82.0	0
derived: sofa_cns	`coalesce(case(gcs_min_48h < 6, 4, gcs_min_48h < 10, 3, gcs_min_48h < 13, 2, gcs_min_48h < 15, 1, 0), 0)`	gcs_min_48h=15.0	0
derived: sofa_renal	`coalesce(case(creat_max_48h >= 5, 4, creat_max_48h >= 3.5, 3, creat_max_48h >= 2, 2, creat_max_48h >= 1.2, 1, 0), 0)`	creat_max_48h=1.02	0
derived: sofa_renal_baseline	`coalesce(case(creat_baseline >= 5, 4, creat_baseline >= 3.5, 3, creat_baseline >= 2, 2, creat_baseline >= 1.2, 1, 0), 0)`	creat_baseline=0.96	0
derived: sofa_delta	`sofa_resp + sofa_coag + sofa_liver + sofa_cardio + sofa_cns + sofa_renal - sofa_renal_baseline`	sofa_resp=0, sofa_coag=0, sofa_liver=0, sofa_cardio=0, sofa_cns=0, sofa_renal=0, sofa_renal_baseline=0	0
derived: sepsis3	`infection_documented and sofa_delta >= t.sofa_delta`	infection_documented=False, sofa_delta=0, t.sofa_delta=2	false
derived: sepsis2	`infection_documented and sirs_count >= t.sirs_min`	infection_documented=False, sirs_count=0, t.sirs_min=2	false
derived: shock	`sepsis3 and norepi_max_48h > 0 and coalesce(lactate_max_48h > t.lactate, false)`	sepsis3=False, norepi_max_48h=0.0, lactate_max_48h=unknown, t.lactate=2	false
outcome: no_infection	`not infection_documented`	infection_documented=False	true

Structured data

Labs (33)

Labs (pre-admission rows are outpatient values)
Row	When	Test	Value
LAB-005781	Sun Sep 28, 2025 09:15 AM	creatinine	0.94 mg/dL
LAB-005782	Sun Sep 20, 2026 10:05 AM	creatinine	0.96 mg/dL
LAB-005783	Sun Nov 08, 2026 07:29 PM	creatinine	1.02 mg/dL
LAB-005789	Sun Nov 08, 2026 07:29 PM	sodium	141.0 mmol/L
LAB-005795	Sun Nov 08, 2026 07:29 PM	hemoglobin	12.76 g/dL
LAB-005801	Sun Nov 08, 2026 07:29 PM	wbc	7.74 x10^3/uL
LAB-005802	Sun Nov 08, 2026 07:29 PM	platelets	186.0 x10^3/uL
LAB-005813	Sun Nov 08, 2026 07:29 PM	bilirubin	0.42 mg/dL
LAB-005784	Mon Nov 09, 2026 05:00 AM	creatinine	0.95 mg/dL
LAB-005790	Mon Nov 09, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005796	Mon Nov 09, 2026 05:00 AM	hemoglobin	11.05 g/dL
LAB-005803	Mon Nov 09, 2026 05:00 AM	wbc	7.37 x10^3/uL
LAB-005804	Mon Nov 09, 2026 05:00 AM	platelets	279.0 x10^3/uL
LAB-005785	Tue Nov 10, 2026 05:00 AM	creatinine	0.96 mg/dL
LAB-005791	Tue Nov 10, 2026 05:00 AM	sodium	138.0 mmol/L
LAB-005797	Tue Nov 10, 2026 05:00 AM	hemoglobin	9.9 g/dL
LAB-005805	Tue Nov 10, 2026 05:00 AM	wbc	6.68 x10^3/uL
LAB-005806	Tue Nov 10, 2026 05:00 AM	platelets	280.0 x10^3/uL
LAB-005786	Wed Nov 11, 2026 05:00 AM	creatinine	0.97 mg/dL
LAB-005792	Wed Nov 11, 2026 05:00 AM	sodium	139.0 mmol/L
LAB-005798	Wed Nov 11, 2026 05:00 AM	hemoglobin	10.7 g/dL
LAB-005807	Wed Nov 11, 2026 05:00 AM	wbc	9.3 x10^3/uL
LAB-005808	Wed Nov 11, 2026 05:00 AM	platelets	254.0 x10^3/uL
LAB-005787	Thu Nov 12, 2026 05:00 AM	creatinine	0.96 mg/dL
LAB-005793	Thu Nov 12, 2026 05:00 AM	sodium	140.0 mmol/L
LAB-005799	Thu Nov 12, 2026 05:00 AM	hemoglobin	11.0 g/dL
LAB-005809	Thu Nov 12, 2026 05:00 AM	wbc	10.98 x10^3/uL
LAB-005810	Thu Nov 12, 2026 05:00 AM	platelets	219.0 x10^3/uL
LAB-005788	Fri Nov 13, 2026 05:00 AM	creatinine	1.0 mg/dL
LAB-005794	Fri Nov 13, 2026 05:00 AM	sodium	136.0 mmol/L
LAB-005800	Fri Nov 13, 2026 05:00 AM	hemoglobin	11.1 g/dL
LAB-005811	Fri Nov 13, 2026 05:00 AM	wbc	8.74 x10^3/uL
LAB-005812	Fri Nov 13, 2026 05:00 AM	platelets	202.0 x10^3/uL

Vitals (90)

Vitals
Row	When	Kind	Value	Detail
VIT-016654	Sun Nov 08, 2026 06:49 PM	spo2	95.0	room air
VIT-016655	Sun Nov 08, 2026 06:49 PM	rr	18.0
VIT-016684	Sun Nov 08, 2026 06:49 PM	temp_c	37.2
VIT-016685	Sun Nov 08, 2026 06:49 PM	hr	76.0
VIT-016686	Sun Nov 08, 2026 06:49 PM	map	82.0
VIT-016687	Sun Nov 08, 2026 06:49 PM	gcs	15.0
VIT-016656	Mon Nov 09, 2026 02:49 AM	spo2	97.0	room air
VIT-016657	Mon Nov 09, 2026 02:49 AM	rr	16.0
VIT-016688	Mon Nov 09, 2026 02:49 AM	temp_c	36.6
VIT-016689	Mon Nov 09, 2026 02:49 AM	hr	68.0
VIT-016690	Mon Nov 09, 2026 02:49 AM	map	89.0
VIT-016691	Mon Nov 09, 2026 02:49 AM	gcs	15.0
VIT-016658	Mon Nov 09, 2026 10:49 AM	spo2	95.0	room air
VIT-016659	Mon Nov 09, 2026 10:49 AM	rr	15.0
VIT-016692	Mon Nov 09, 2026 10:49 AM	temp_c	36.5
VIT-016693	Mon Nov 09, 2026 10:49 AM	hr	78.0
VIT-016694	Mon Nov 09, 2026 10:49 AM	map	91.0
VIT-016695	Mon Nov 09, 2026 10:49 AM	gcs	15.0
VIT-016660	Mon Nov 09, 2026 06:49 PM	spo2	97.0	room air
VIT-016661	Mon Nov 09, 2026 06:49 PM	rr	18.0
VIT-016696	Mon Nov 09, 2026 06:49 PM	temp_c	37.1
VIT-016697	Mon Nov 09, 2026 06:49 PM	hr	87.0
VIT-016698	Mon Nov 09, 2026 06:49 PM	map	84.0
VIT-016699	Mon Nov 09, 2026 06:49 PM	gcs	15.0
VIT-016662	Tue Nov 10, 2026 02:49 AM	spo2	94.0	room air
VIT-016663	Tue Nov 10, 2026 02:49 AM	rr	15.0
VIT-016700	Tue Nov 10, 2026 02:49 AM	temp_c	36.8
VIT-016701	Tue Nov 10, 2026 02:49 AM	hr	74.0
VIT-016702	Tue Nov 10, 2026 02:49 AM	map	82.0
VIT-016703	Tue Nov 10, 2026 02:49 AM	gcs	15.0
VIT-016664	Tue Nov 10, 2026 10:49 AM	spo2	94.0	room air
VIT-016665	Tue Nov 10, 2026 10:49 AM	rr	19.0
VIT-016704	Tue Nov 10, 2026 10:49 AM	temp_c	37.0
VIT-016705	Tue Nov 10, 2026 10:49 AM	hr	81.0
VIT-016706	Tue Nov 10, 2026 10:49 AM	map	92.0
VIT-016707	Tue Nov 10, 2026 10:49 AM	gcs	15.0
VIT-016666	Tue Nov 10, 2026 06:49 PM	spo2	98.0	room air
VIT-016667	Tue Nov 10, 2026 06:49 PM	rr	17.0
VIT-016708	Tue Nov 10, 2026 06:49 PM	temp_c	37.5
VIT-016709	Tue Nov 10, 2026 06:49 PM	hr	82.0
VIT-016710	Tue Nov 10, 2026 06:49 PM	map	76.0
VIT-016711	Tue Nov 10, 2026 06:49 PM	gcs	15.0
VIT-016668	Wed Nov 11, 2026 02:49 AM	spo2	98.0	room air
VIT-016669	Wed Nov 11, 2026 02:49 AM	rr	14.0
VIT-016712	Wed Nov 11, 2026 02:49 AM	temp_c	36.8
VIT-016713	Wed Nov 11, 2026 02:49 AM	hr	83.0
VIT-016714	Wed Nov 11, 2026 02:49 AM	map	87.0
VIT-016715	Wed Nov 11, 2026 02:49 AM	gcs	15.0
VIT-016670	Wed Nov 11, 2026 10:49 AM	spo2	99.0	room air
VIT-016671	Wed Nov 11, 2026 10:49 AM	rr	20.0
VIT-016716	Wed Nov 11, 2026 10:49 AM	temp_c	36.8
VIT-016717	Wed Nov 11, 2026 10:49 AM	hr	72.0
VIT-016718	Wed Nov 11, 2026 10:49 AM	map	87.0
VIT-016719	Wed Nov 11, 2026 10:49 AM	gcs	15.0
VIT-016672	Wed Nov 11, 2026 06:49 PM	spo2	99.0	room air
VIT-016673	Wed Nov 11, 2026 06:49 PM	rr	16.0
VIT-016720	Wed Nov 11, 2026 06:49 PM	temp_c	37.0
VIT-016721	Wed Nov 11, 2026 06:49 PM	hr	84.0
VIT-016722	Wed Nov 11, 2026 06:49 PM	map	88.0
VIT-016723	Wed Nov 11, 2026 06:49 PM	gcs	15.0
VIT-016674	Thu Nov 12, 2026 02:49 AM	spo2	94.0	room air
VIT-016675	Thu Nov 12, 2026 02:49 AM	rr	14.0
VIT-016724	Thu Nov 12, 2026 02:49 AM	temp_c	37.4
VIT-016725	Thu Nov 12, 2026 02:49 AM	hr	90.0
VIT-016726	Thu Nov 12, 2026 02:49 AM	map	88.0
VIT-016727	Thu Nov 12, 2026 02:49 AM	gcs	15.0
VIT-016676	Thu Nov 12, 2026 10:49 AM	spo2	96.0	room air
VIT-016677	Thu Nov 12, 2026 10:49 AM	rr	18.0
VIT-016728	Thu Nov 12, 2026 10:49 AM	temp_c	36.7
VIT-016729	Thu Nov 12, 2026 10:49 AM	hr	81.0
VIT-016730	Thu Nov 12, 2026 10:49 AM	map	76.0
VIT-016731	Thu Nov 12, 2026 10:49 AM	gcs	15.0
VIT-016678	Thu Nov 12, 2026 06:49 PM	spo2	95.0	room air
VIT-016679	Thu Nov 12, 2026 06:49 PM	rr	18.0
VIT-016732	Thu Nov 12, 2026 06:49 PM	temp_c	37.2
VIT-016733	Thu Nov 12, 2026 06:49 PM	hr	81.0
VIT-016734	Thu Nov 12, 2026 06:49 PM	map	78.0
VIT-016735	Thu Nov 12, 2026 06:49 PM	gcs	15.0
VIT-016680	Fri Nov 13, 2026 02:49 AM	spo2	98.0	room air
VIT-016681	Fri Nov 13, 2026 02:49 AM	rr	20.0
VIT-016736	Fri Nov 13, 2026 02:49 AM	temp_c	36.9
VIT-016737	Fri Nov 13, 2026 02:49 AM	hr	69.0
VIT-016738	Fri Nov 13, 2026 02:49 AM	map	74.0
VIT-016739	Fri Nov 13, 2026 02:49 AM	gcs	15.0
VIT-016682	Fri Nov 13, 2026 10:49 AM	spo2	99.0	room air
VIT-016683	Fri Nov 13, 2026 10:49 AM	rr	17.0
VIT-016740	Fri Nov 13, 2026 10:49 AM	temp_c	36.8
VIT-016741	Fri Nov 13, 2026 10:49 AM	hr	79.0
VIT-016742	Fri Nov 13, 2026 10:49 AM	map	79.0
VIT-016743	Fri Nov 13, 2026 10:49 AM	gcs	15.0

Medications, orders, echo, history (1)

ORD-000148 11-09 09:00 transfusion_prbc: transfuse PRBC

Notes

History and physical · DOC-000569 · Dr. Elena Nakashima (resident) · Sun Nov 08, 2026 09:29 PM

Cited facts from this note (1)

bleeding_source: hematemesis · cited p. 1, line 5 · confidence 0.85

Show source for bleeding_source

… vice: Hospital Medicine Attending: Dr. Cyrus Ellingham History of present illness: 89-year-old man admitted with upper GI bleed. Presented after two days of hematemesis; GI consulted for endoscopy. Past medical history: GERD. Review of systems otherwise negative. Exam: Lungs: clear to auscultation bilaterally. Assessment and p …

Source document DOC-000569: History and physical (synthetic)

HISTORY AND PHYSICAL
Patient: Lena Okafor   MRN: MRN85625659   Admitted: 2026-11-08 18:29
Service: Hospital Medicine   Attending: Dr. Cyrus Ellingham

History of present illness: 89-year-old man admitted with upper GI bleed. Presented after two days of hematemesis; GI consulted for endoscopy.
Past medical history: GERD.
Review of systems otherwise negative.
Exam: Lungs: clear to auscultation bilaterally.
Assessment and plan:
1. Upper GI bleed: PPI, GI following.

Wound care note · DOC-000568 · Ines Ingram, RN, CWOCN (wound_nurse) · Mon Nov 09, 2026 09:29 PM

Cited facts from this note (2)

wound_site: sacral · cited p. 1, line 4 · confidence 0.95

Show source for wound_site

WOUND CARE NOTE Patient: Lena Okafor MRN: MRN85625659 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 4.7 x 2.1 x 0.7 cm. Plan: offloading every 2 hours, foam dressing, nutriti …
wound_stage: 2 · cited p. 1, line 5 · confidence 0.95

Show source for wound_stage

WOUND CARE NOTE Patient: Lena Okafor MRN: MRN85625659 Location: sacrum Stage: 2 (NPIAP) Description: partial-thickness skin loss with exposed dermis. Size: 4.7 x 2.1 x 0.7 cm. Plan: offloading every 2 hours, foam dressing, nutrition consul …

Source document DOC-000568: Wound care note (synthetic)

WOUND CARE NOTE
Patient: Lena Okafor   MRN: MRN85625659

Location: sacrum
Stage: 2 (NPIAP)
Description: partial-thickness skin loss with exposed dermis.
Size: 4.7 x 2.1 x 0.7 cm.
Plan: offloading every 2 hours, foam dressing, nutrition consult.

Progress note · DOC-000570 · Dr. Elena Nakashima (resident) · Fri Nov 13, 2026 01:55 PM · awaiting cosign

Source document DOC-000570: Progress note (synthetic)

PROGRESS NOTE (Resident)
Patient: Lena Okafor   MRN: MRN85625659   Hospital day 5

Subjective: resting, tolerating diet.
Objective: vitals and labs reviewed in the flowsheet.
Assessment and plan:
1. Upper GI bleed: continue current management.
2. Stage 4 sacral pressure ulcer: wound care following, offloading.

Resident: Dr. Elena Nakashima   Attending cosign: pending